But the public reports on the two men’s recent health-related episodes, written by their primary-care military physicians, do not serve voters well. The fault, however, is not with the physicians but with the absence of explicit standards for disclosing health records of presidents and presidential candidates — an eminently rectifiable situation.
Both medical reports omit critically pertinent prognostic data that the physicians certainly know. Sanders had a heart attack in October, but his report is silent about the extent of disease in his coronary arteries, which is the most important factor in determining his risk for another heart attack. The report on Trump’s abrupt, unscheduled visit to Walter Reed National Military Medical Center in November listed several key cardiovascular symptoms the president did not have, but failed to say whether he was free from the sensations of chest squeezing and left arm discomfort that patients classically experience during heart attack and its precursors.
Voters need and deserve health information from candidates because a vote is fundamentally a bet on the future, reflecting the voter’s estimate of the candidate’s ability to lead the nation toward the voter’s desired endpoint. As Woodrow Wilson’s stroke-shattered presidency proves, sickness sidelines effectiveness. Prognostic medical information, unlike knowledge of tax returns or scandals, is directly relevant because illness physically impedes exercise of the office.
Formulating standards on which medical data to disclose vs. which will remain private should be based on the duties of the presidency as enumerated in the Constitution. These duties are surprisingly few, and demand just four essential physical functions from a president: receiving information via sight and/or hearing, processing information in the brain, communicating decisions intelligibly, and staying alive. Medical conditions that might significantly impair these functions over the next four years should be disclosed to voters. All others are no business of the public.
The rub is defining “significantly.” Fortunately, military medicine has long experience doing exactly this, by defining medical standards for specific jobs — pilot, parachutist, cook, etc. Among these, in my experience, the mental and physical demands on air traffic controllers most closely track the four essential “presidential” functions. The Air Force lists hundreds of medical conditions that disqualify air traffic controllers by threatening the four functions, including heart attack, psychosis and non-trivial cancers. Subtract from this list the musculoskeletal requirements of general military service (the campaign trail’s rigors can substitute as a stamina test), and the remaining conditions well describe the medical threats to the exercise of the presidency. Military physicians work with such lists daily.
Thus, as a first cut, I would propose a policy (better, a law) requiring presidential and vice presidential candidates to publicly disclose complete information on every non-musculoskeletal medical condition they have that would disqualify them from being an air traffic controller in the Air Force.
Defining “complete” is another rub, but here, too, military precedents help. The Air Force’s procedure to reinstate a medically disqualified air traffic controller includes reviewing an extract of the service member’s medical record. Again, for hundreds of different conditions, the Air Force specifies exactly what data elements must be included in the extract. The report on Sanders was incomplete by Air Force standards because appeals for reinstatement after a heart attack must include a full description of coronary artery anatomy.
Presidential physicians, especially, should welcome explicit standards that are insulated from political pressure. Currently, each public medical disclosure about a president results from a doubtlessly fraught negotiation between patient and physician, potentially exposing the physician to charges of conspiring in coverups. With explicit standards the country would know exactly what the physician means by “fit for duty,” thereby avoiding adversarial speculations such as those surrounding Trump’s visit to Walter Reed.
It is important to emphasize that any medical standard for the presidency would only be a standard for disclosure. In no case would the standard bar someone from holding office because of a medical condition. That would be up to the voters, as it has been every four years since 1788.